Case Management Guide: Disability Related Health Supports

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FOI 24/25-0753

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Case Management Guide

Field Category Reference Documents
Common disability-related health supports the NDIA is able to fund Dysphagia supports

- low-cost assistive technology (equipment or devices to help a participant eat and drink)
- thickener products
- help to prepare specific foods
- a support worker
- a speech pathologist, to make and implement a mealtime management plan and train support workers, family and/or carers

Nutrition supports

- a dietitian, to create a disability-related meal plan for a participant
- support to help follow that meal plan
- Home Enteral Nutrition (HEN) and Percutaneous Endoscopic Gastrostomy (PEG) equipment
- other products which may help a participant eat safely, and acquire the nutrition they need (such as food thickeners)
- support to manage HEN and PEG strategies

Diabetes management supports

- a nurse or otherwise qualified person to create a disability-related diabetes management plan
- support to follow that management plan
- a support worker, to monitor glucose levels and administer insulin or other medication
- training for support workers
- a nurse or otherwise qualified person to monitor glucose levels and administer insulin or other medication (for participants with unstable diabetes, and/or complex disability support needs)
- assistive technology to help manage diabetes, which a participant is otherwise unable to acquire through the healthcare system
Dysphagia supports

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FOI 24/25-0753

OFFICIAL For Internal Use Only

Case Management Guide

Field Category Reference Documents
Continence supports

- pads and/or nappies
- bedding and/or chair protection
- liners or shields
- anal plugs
- collection bags
- bottles
- straps or tape
- training for support workers or other supports to assist a participant with bodily functions and hygiene
- continence assessment(s)
- a bed wetting alarm

Wound and pressure care supports

- a registered/clinical nurse/clinical nurse consultant to develop a chronic wound management plan or pressure care plan
- a support worker, enrolled/registered/clinical nurse to help implement that management plan
- training for a support worker or other supports to help implement the wound and pressure management plan
- wound care items (gauze, bandages, dressing and tape)
- items to prevent wounds (including pressure relief cushions, moisturiser, barrier creams and non-PH washes)
- support to manage lymphoedema, either by a trained support worker, or by a qualified lymphoedema practitioner.

Podiatry supports

- an initial consultation and assessment by a podiatrist, including the development of a podiatry care plan
- regular re-assessment(s) during a care plan
- appointments with a podiatrist to assist with overall foot care and foot health
- a support worker to be trained in foot care tasks that do not require the care of a professional.

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FOI 24/25-0753

OFFICIAL For Internal Use Only

Case Management Guide

Field Category Reference Documents
- assistive technology (orthoses, medical grade/custom footwear, as well as maintenance and repair)

Epilepsy supports

- funding and training for a support worker to follow an epilepsy management plan
- a High Intensity support worker to monitor seizures and provide support during and after a seizure, by following the epilepsy management plan and epilepsy emergency medication plan
- assistive technology (such as alarms or seizure monitors)
- support coordination

Please note, in relation to the above, training may include Registered Nurse Delegation and Supervision of Care (DSOC) for Standard or High Intensity support skills
Approach to ART matters The NDIA will fund all reasonable and necessary disability-related health supports which are NDIS supports, most appropriately funded by the NDIS. How do we work out who should fund or provide your supports?
Evidence recommended The NDIA must first consider whether a particular support would be more appropriately funded by the NDIS or any other mainstream service system.

The nature and level of evidence then required to inform the NDIA position will depend on the particular disability and support in question.

For example, funding for:

- dysphagia supports — will be informed by evidence provided by a speech pathologist
- nutrition supports — will be informed by evidence provided by a dietitian, or other suitably qualified health professional
- continence supports — will be informed by evidence provided by a continence nurse, or other suitably qualified health professional
Persons Giving Expert and Opinion Evidence Guideline

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FOI 24/25-0753

OFFICIAL For Internal Use Only

Case Management Guide

Field Category Reference Documents
- diabetes management supports, wound and pressure care supports, podiatry supports, and epilepsy supports — will be informed by evidence provided by a suitably qualified health professional

Matters concerning the provision of disability-related health supports will turn on the facts of each particular case, and the evidence available. The NDIA will seek to ensure the best possible evidence is made available to help guide the ART towards the best possible outcome for the participant.
Other considerations Where a Participant also receives support from any other mainstream service delivery system, the NDIA expects that the Participant ensures NDIS funding is not used to fund support/s of the kind funded by that other mainstream service delivery system.
Previous relevant decisions Funding for general support to maintain an eating plan, as well as thickened fluids and nutritional supplements constitutes a reasonable and necessary support. The AAT set aside the decision under review.

Additional funding for continence products was not a reasonable and necessary support, as existing plan funding for continence products remained unused.

In the absence of any evidence supporting the participant’s request for specialised shoes, the AAT could not be satisfied that it would be reasonable or necessary for the NDIA to fund that support.

The AAT Affirmed the decision under review.
Burchell and National Disability Insurance Agency [2019] AATA 1256

Hoolachan and National Disability Insurance Agency [2019] AATA 4798
Document Control Responsible Person Date
Document author Continuous Improvement November 2024
Document approver Director, Continuous Improvement 20 November 2024

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